Provider Demographics
NPI:1750703484
Name:CONN, COURTNEY (PHD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:CONN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2012
Mailing Address - Country:US
Mailing Address - Phone:202-686-7699
Mailing Address - Fax:
Practice Address - Street 1:5247 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 4
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:202-686-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000923103TC0700X
VA0810004731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical